Some markers of endothelial dysfunction in patients with hypertension with combined pathology

Abstract

Background. Searching markers of endothelial dysfunction, the pathogenetic basis of arterial hypertension and the entire cascade of diseases of the cardiovascular system, is an urgent task. The purpose of the study was to determine the correlation of markers of endothelial dysfunction – highly sensitive C-reactive protein and cerebral natriuretic propeptide with the main laboratory parameters in hypertension in conditions of comorbid pathology. Materials and methods. The study involved 3 groups of 45 patients aged 40 to 69 years with arterial hypertension: in the first group in combination with cardiorenal syndrome, in the second – with metabolic and cardiorenal syndromes, in the third – with chronic renal pathology; the control group included 38 patients aged 40 to 63 years without a cardiovascular history. Research methods: anthropometry with calculation of body mass index; auscultative blood pressure tonometry; ultrasound examination of the heart; laboratory examination of general blood analysis, urine, biochemical blood analysis, highly sensitive C-reactive protein, cerebral natriuretic propeptide, cystatin C, blood lipid spectrum, albuminuria. Results. The presence in patients of chronic heart failure with intermediate and reduced ejection fraction, confirmed by values of cerebral natriuretic propeptide above 145 pg/ml and chronic kidney disease with moderate (C3a A2) and significantly reduced renal function (C3b A2) indicate the course of chronic type cardiorenal syndrome in 62,1% of the first and second 82,2% of the second group. In patients of the third group, chronic kidney disease is accompanied by preserved (C1 A0) and slightly reduced renal function (C2 A1-2). High values of highly sensitive C-reactive protein were diagnosed in patients of the first and second groups, minimal values in the control group; in patients of the first and second groups, the dependence of the marker concentration on blood pressure and atherogenic lipids was revealed. There was no significant correlation between the concentration of cerebral natriuretic propeptide and the level of decreased renal function. The linear dependence of the values of highly sensitive C-reactive protein and brain natriuretic propeptide in patients of the first and second groups was revealed. Conclusions. The level of highly sensitive C-reactive protein is closely correlated with blood pressure, atherogenic lipid fraction and cerebral natriuretic propeptide, more pronounced in patients with combined pathology. In individuals with low cardiovascular risk, an increased level of highly sensitive C-reactive protein can be considered as a marker of endothelial dysfunction and a predictor of the development of cardiovascular diseases. The level of cerebral natriuretic propeptide does not depend on the state of renal function.

Keywords

• arterial hypertension
• metabolic syndrome
• endothelial dysfunction
• cardiovascular and renal pathologies
• dyslipidemia
• highly sensitive c-reactive protein
• natriuretic propeptide